Ultrasound-guided procedures and investigations: a manual for the clinician

208 Pages·2006·5.833 MB·English

by  Armin Ernst, David J Feller-Kopman

Ultrasound–Guided
Procedures and
Investigations
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Ultrasound–Guided
Procedures and
Investigations
A Manual for the Clinician
edited by
Armin Ernst
Beth Israel Deaconess Medical Center
Boston, Massachusetts, U.S.A.
David J. Feller–Kopman
Beth Israel Deaconess Medical Center
Boston, Massachusetts, U.S.A.
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DK3594_Discl.fm Page 1 Monday, August 29, 2005 11:02 AM
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Preface
In the last few years, ultrasonography has become increasingly recog-
nized as a helpful tool for the evaluation and management of patients
in the intensive care unit, emergency department, and the operating
room, as well as general hospital wards and outpatient clinics. Ultra-
sound guidance in thoracentesis and central venous catheterization is
becoming the standard of care, and use of ultrasonography has signifi-
cantly expedited the initial evaluation of the trauma patient. With the
development of affordable and portable devices, ultrasound examina-
tions are increasingly performed by nonradiologists.
This book is intended to serve as a resource for internists, pulmo-
nologists, critical care physicians, surgeons, emergence medicine physi-
cians, and anesthesiologists, as well as physicians in training. The
chapters have been organized to provide a background in physics and
imagingtechnology,reviewtheliteraturepertinenttothemostcommonly
performed procedures and nonprocedural applications of ultrasono-
graphy, and provide guidance on how to perform those examinations
and procedures.
Itisourhopethatthisbookwillinspirenonradiologiststobecome
familiar with ultrasound and begin to use it as a tool in daily clinical
practice in order to enhance patient care.
ArminErnst
DavidFeller-Kopman
iii

Contents
Preface . . . . iii
Contributors . . . . ix
1. ABCs of Ultrasound Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
James F. Greenleaf
Introduction . . . . 1
Elements of Ultrasound Imaging . . . . 2
Image Acquisition . . . . 5
System Description . . . . 5
Signal Processing . . . . 11
Display . . . . 14
References . . . . 16
2. Ultrasound Guidance for Central Venous Catheterization . . . . . . . . 17
Momen M. Wahidi
Introduction . . . . 17
Definitions . . . . 18
Ultrasound as an Imaging Modality for Vessels . . . . 18
Technical Aspects . . . . 21
Evidence Supporting the Use of Ultrasound in Central
Venous Access . . . . 23
Current Use and Future Directions . . . . 27
Other Uses of Ultrasound in Venous Access . . . . 28
Credentialing and Training . . . . 29
Summary . . . . 29
References . . . . 31
3. Ultrasound-Guided Thoracentesis . . . . . . . . . . . . . . . . . . . . . . . . 35
David Feller-Kopman
Introduction . . . . 35
Technical Aspects . . . . 35
Ultrasonographic Features of Effusions . . . . 37
v
vi Contents
Guidance for Thoracentesis . . . . 39
Pneumothorax . . . . 40
Summary . . . . 41
References . . . . 42
4. Ultrasound-Guided Percutaneous Drainage . . . . . . . . . . . . . . . . . . 45
F. J. F. Herth
Malignant Effusions . . . . 45
Parapneumonic Effusions/Empyemas . . . . 46
Lung Abscess . . . . 47
Pneumothorax . . . . 51
Technique of Ultrasound-Guided Drainage . . . . 52
Technique of Pleurodesis . . . . 55
Complications . . . . 57
Summary . . . . 58
References . . . . 59
5. Ultrasound-Guided Transthoracic Needle Biopsy . . . . . . . . . . . . . . 63
Peter Doelken
Introduction . . . . 63
Ultrasound Equipment . . . . 65
Imaging . . . . 66
Fine Needle Aspiration . . . . 67
Core Needle Biopsy . . . . 67
Lung . . . . 68
Pleura . . . . 69
Mediastinum . . . . 70
Contraindications . . . . 70
Complications . . . . 71
Conclusion . . . . 72
References . . . . 73
6. The Use of Ultrasound in Trauma . . . . . . . . . . . . . . . . . . . . . . . . 75
Carlo L. Rosen, Carrie D. Tibbles, and Jason A. Tracy
Introduction . . . . 75
Advantages and Disadvantages . . . . 76
Indications . . . . 76
Technique and Findings . . . . 77
Blunt Abdominal Trauma . . . . 82
Detection of Hemothorax . . . . 89
Penetrating Abdominal Trauma . . . . 90
Contents vii
Penetrating Chest Trauma . . . . 91
Summary . . . . 93
References . . . . 94
7. Emergent Pelvic Ultrasound . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Chris Moore
Approach to Pelvic Ultrasound . . . . 97
Ultrasound in Early Pregnancy . . . . 102
Ultrasound in Later Pregnancy . . . . 110
Pelvic Ultrasound in the Nonpregnant Patient . . . . 112
Fluid in the Pelvis . . . . 114
References . . . . 118
8. Basic Cardiac Echo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
Paul Mayo
Introduction . . . . 121
Technical Issues . . . . 121
The Complete Echocardiogram . . . . 122
Training, Competence, and Certification Issues . . . . 125
Clinical Applications of Echocardiography by the
Noncardiologist . . . . 130
Conclusion . . . . 133
References . . . . 134
9. Documentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
Michael J. Simoff
Introduction . . . . 139
Reports . . . . 140
Protocols . . . . 142
Study Documentation . . . . 142
Report Documentation . . . . 144
The Report . . . . 146
Summary . . . . 146
References . . . . 147
10. Ultrasound: Future Directions . . . . . . . . . . . . . . . . . . . . . . . . . . 149
Christopher J. Harvey, Martin J. K. Blomley, and
David O. Cosgrove
Introduction . . . . 149
Components of a Real-Time B-Mode Ultrasound System . . . . 151
Summary . . . . 176
References . . . . 177